Mentions from the Bard raise questions about treatment during his time.
By Peter J. Koehler
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Figure 1. William Shakespeare (1564-1616), engraving by Martin Droeshout (public domain) |
A while ago, I was asked to collaborate on a podcast about migraine in William Shakespeare’s time. Although I had written about the history of migraine not long ago, it inspired me to delve deeper into this particular period. How was migraine defined or diagnosed, and what treatments were available? There are a number of articles and chapters in medical literature about neurology, headaches in particular, in the works of Shakespeare.
Shakespeare and His Son-in-Law
English playwright and poet William Shakespeare was born in Stratford-upon-Avon and is known as the “Bard of Avon.” He wrote a vast body of work that includes no fewer than 39 plays and 154 sonnets. His oldest child, Susanna married a local physician named John Hall. Hall studied at Queen’s College Cambridge. However, he had no English medical degree and probably received medical training on the continent.
Hall established himself in Stratford around 1600 and is often claimed to be the source of medical information in Shakespeare’s writings, although about half of his plays were written before Hall came to Stratford. Shakespeare wrote about medical issues before meeting Hall, but he did not write about physicians. This changed after 1605. Neurologist John M.S. Pearce wondered, “Do these, taken together, represent an affectionate and admiring sketch of his son-in-law, John Hall?”
Charcot’s Interest in Shakespeare
There is another interesting relationship between Shakespeare and neurology. It is well known that Jean-Martin Charcot was particularly interested in Shakespeare’s work.
Quotes from the famous poet are referenced in several places, including in the book Charcot: Constructing Neurology and the chapter “The Influence of Shakespeare on Charcot’s Neurological Teaching.” Charcot’s biographer Christopher Goetz, the author of the chapter, writes: “Occasionally, he drew on Shakespeare’s words to illustrate a specific neurological observation. More often, he lauded Shakespeare as an exemplary observer of human behavior and emphasized the clinical importance of careful and dispassionate documentation.” Furthermore, Charcot “used Shakespeare’s words to communicate philosophical principles related to the field of medicine and the role the physician.”
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Figure 2. Jean-Martin Charcot (1825- 1893), whose bicentennial of birth is being celebrated this year. © The National Library of Medicine believes this item to be in the public domain; see Jean Martin Charcot ⧉ - Digital Collections - National Library of Medicine. |
An interesting aspect mentioned by Goetz is that Charcot appreciated “the particular mixture of the real and the unreal” in Shakespeare’s Macbeth. This was related to Charcot’s study of hysterics from 1878 onward and “the spectacular behaviors of the hysterics who crowded his wards, and whose symptoms were often mixtures of real and elaborated disease.” These patients “often unwittingly mimicked the witches and spirits of the Shakespearean stage.”
Headache in Othello and Migraine in Romeo and Juliet
Among Shakespeare’s best known tragedies are Hamlet, King Lear, Macbeth, Othello, and Romeo and Juliet. In the latter two plays, headache and migraine are mentioned. In The Tragedy of Othello, the Moor of Venice (Act III, scene 3), the protagonist, who is falsely manipulated with insinuations that his wife is unfaithful to him, says: “I have a pain upon my forehead here,” upon which his wife Desdemona answers, “Faith, that’s with watching; ‘twill away again: Let me but bind it hard, within this hour it will be well.”
In Act II, scene 5 of The Tragedy of Romeo and Juliet, the nurse, Juliet’s personal attendant and confidante, who secretly contacted Romeo, says, “Lord, how my head aches! What a head have I! It beats as it would fall in 20 pieces.”
Philip Barrough’s Method of Physic
If we want to understand the knowledge about headaches and migraines at that time, we must realize that physicians were still thinking in terms of the humoral medicine of antiquity (Galenic medicine). Frequent references were made to Galen and Hippocrates. Health and disease depended on the proper balance of body fluids, including blood, phlegm, and yellow and black bile.
A good example from the period of Shakespeare would be the first edition of Method of Physic, by London surgeon and physician Philip Barrough, who wrote in terms of Galenic medicine.
Barrough first gave general information on headache in his 1583 book on medicine. In his definition, it was localized on one side of the head. He believed this was due to the falx cerebri. He described symptoms, including pain on one side of the head, often periodic (fits), felt on the skull or deep in the brain, sometimes the temples. As for the pathophysiology, he wrote in terms of vapors rising, hot or cold, and if the meninges are involved, it can be very painful, with the patient barely able to touch the skin.
As for the treatment, he wrote, “The patient should refrain from such things as do send abundance of sharp vapors up to the head (garlicke, oynions, mustard, raddishe rootes, and such like).” The patient should rub either their own fingers or a linen cloth over the half of the forehead that is hurt, and specially over the muscles of the temples, until it is red and hot.
Of course, Shakespeare did not give much information about the symptoms of his characters’ headaches. Although it is hazardous to make a diagnosis based on so little information from the 16th century, the “pain in the forehead” of Othello, could have been a tension-type headache. The description of the headache — [the head] “beats as it would fall in 20 pieces” — of Juliet’s nurse suggests migraine. Shakespeare also gave no information about treatment, other than “Let me but bind it hard.” And the information he gave would not have required reading medical writings.
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World Neurology | Jan-Feb 2025, Volume 40, No. 1
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